The Value of Listening

Little did I know when I spoke those words in a 7th
grade oratorical contest how fundamental the skill of listening would be to my
future vocation, OUR VOCATION, as family physicians.

The skill, the arts of listening, understanding and
communicating with passion and compassion are fundamental to family medicine.

These same skills: listening, understanding, and
communicating with passion and compassion are the skills that we use as
physician leaders. We are leaders in our practices, in our hospitals, and in
our communities.

As KAFP charts the course towards 70 years as an
organization I would like to challenge each of us to:

Expand our leadership in our communities

Expand the community of our leadership

Here are four areas on which I suggest we focus:

Public Health: As
family physicians, we focus on preventive care, continuity of care with evidence-
based medicine, and care coordination.
These principles overlap with those of public health. As family physicians, we have a unique
opportunity to incorporate concepts of public health into family medicine.

As examples, it will be more cost effective to:

Address obesity at the community level

Address fitness at the community level

It is more successful to prevent tobacco use
than to stop the addiction.

Here is an example of community family medicine extending
into the community and overlapping with public health:

Drs. Doug and Shelly Gruenbacher are family physicians
practicing in Quinter, Kansas. They
recognized a need for a fitness center, and worked with other community leaders
to fundraise for this fitness center.
Included in their fundraising activities is an annual race, which
further exemplifies the role of fitness in the community. With successful fundraising, Quinter now has
an affordable fitness center, with a variety of fitness opportunities to
benefit all members of the community.
This is a GREAT example of integrating community health goals into
primary care.

EHR: As effective
as we are at listening, we still need tools to help us hear our patients more
effectively. The stethoscope is an
example of a classic tool. In the next
several years, our electronic health records will include tools that help us to
“hear” our patients and our communities more effectively.

Two patient encounter examples can serve as examples:
George, and Lisa, will help demonstrate the use of the near-future EHR to help
us hear our patients more effectively.

George is a 77 year-old with mild dementia, and DM 2.

He lives by himself.

His daughter visits him, from out of town, each month for
several days, to help him with long-term needs.

She has arranged for a neighbor to do his weekly grocery
shopping, and to check in on him. Review
of George’s home glucose records reveals a significant increase in the last 2
months.

His pill count indicates he is taking his meds.

His neighbor reports that his grocery list is unchanged.

His weight is up 4 pounds since his last visit.

Fortunately, in preparation for today’s visit, the health
landscape map in the EHR reveals a convenience store down the street from
George’s house. George confirms that, as
the weather has gotten nicer, he has been ‘exercising’ by walking to the store,
and rewards himself by purchasing a 32 oz soda, and a box of doughnuts!

Lisa is a 13 year-old brought in by her mom.

Mom is a single parent, and works days.

Lisa has been increasingly disruptive in the classroom, and
her grades, never great, have gotten worse.

Fortunately, Lisa and her mom completed an on-line survey
prior to the visit.

The survey flags findings that suggest Lisa meets the
criteria for ADHD; and that Lisa has used tobacco. After an appropriate evaluation, the office
care coordinator contacts the school and helps facilitate getting Lisa the
counseling and school help that she needs.

On discussing the tobacco, Lisa acknowledges that she DID
smoke, but TOBACCO 21 made cigarettes inaccessible; and the $1.50 additional
tax increase made it financially impossible.
She no longer smokes.

Social Determinants
of Health: These encounters exemplify the incorporation of social
determinants of health into the electronic health record. Social determinants of health can be
described as the variables of where we live, learn, work and play; and the
impact these variables have on our health and well-being.

These changes in our EHR, the incorporation of the Health
Landscape map, and the inclusion of the social determinants of health in our
records, are examples of changes that will help us to ‘hear’ our patients more
effectively. KAFP will continue to help
provide us the resources to adjust to these changes as effectively and
efficiently as possible.

Burnout and Physician
Well-being: Rapid change in our offices can be exhausting. Unfortunately the electronic health records
and the increased administrative tasks that accompany change do pose a risk to
our professional well-being. These stresses accelerate the development of
physician burnout.

In 2011, the burnout rate among family physicians was 51
percent. In 2014 the burnout rate among family physicians had increased to 63
percent.

Early retirement (not what we need in a
specialty that needs more of us!)

Alcohol use

Suicidal ideation

Increased stress on our families

Burnout not only affects us, it also affects all members of
our health care team, the same staff that we are increasingly inter-independent
on as a key component of our Patient Centered Medical Home teams.

What to do?!

First, recognize the symptoms of burnout.

Second, recognize there is not a simple ‘fix’. But there are strategies that can help
maintain a balance between work, and life away from work.

Both the KAFP and the AAFP recognize the increasing prevalence
of physician burnout. The KAFP will continue to share with you information and
resources to help you navigate these challenges.

As we chart the course towards 70 years, it is reassuring to
know that we have an incredibly strong KAFP.
Our strength is in our history, our membership, and our outstanding
administrative staff.